Graf和Herck法超声检查联合检查在婴幼儿髋关节发育不良中筛查临床价值

探讨Graf和Herck法超声检查及两者联合检查在婴幼儿髋关节发育不良中筛查临床价值。选取2015年3月~2016年1月我院收治的疑是婴幼儿髋关节发育不良患儿80例作为研究对象,分别采用Graf和Herck法超声检查,对患儿随访1年后以X线和临床诊断为"金标准",判定Graf和Herck法超声检查在婴幼儿髋关节发育不良中筛查灵敏度、特异性和阳性符合率。结果 80例患儿经"金标准"诊断,24例婴幼儿为髋关节发育不良。Graf法超声检查在婴幼儿髋关节发育不良中诊断灵敏度为75.00%、特异性为91.07%、阳性符合率为86.25%。Herck法超声检查在婴幼儿髋关节发育不良中诊断灵敏度为83.33%、特异性为92.86%、阳性符合率为90.00%。Graf联合Herck法超声检查在婴幼儿髋关节发育不良中诊断灵敏度为95.83%、特异性为87.50%、阳性符合率为90.00%。联合诊断灵敏度高于Graf与Herck单独诊断(P0.05);特异性和阳性符合率无显著差异(P0.05)。Graf和Herck法超声检查在婴幼儿髋关节发育不良中均有较高筛查价值,两者联合检查可提高诊断灵敏度。     

Graf法超声在1500例婴儿高危发育性髋关节发育不良诊断中的应用价值

目的探讨分析Graf法超声在1500例婴儿高危发育性髋关节发育不良(DDH)诊断中的应用价值。方法回顾性分析2014年3月至2015年9月期间在深圳市宝安区妇幼保健院出生的1500例DDH多种高危因素新生儿为研究对象,行Graf法超声检查。比较不同高危因素患儿的DDH发病率,及合并2种、3种、4种高危因素患儿的DDH发病率;比较异常与正常髋关节α角、β角的差异;同时将临床查体及X线检查作为“金标准”,评估Graf法超声对DDH的诊断效能。结果1500例婴儿中,DDH检出率为21.00%;女性、臀位分娩、有家族史、伴有其他骨骼肌肉畸形的DDH检出率分别为23.04%、25.32%、24.07%、24.51%,均高于男性、非臀位分娩、无家族史、不伴有其他骨骼肌肉畸形者(9.38%、4.76%、12.41%、17.81%),差异有统计学意义(P<0.05)。合并2种、3种、4种高危因素DDH检出率分别为18.28%、23.06%、33.82%;合并不同数量高危因素患者DDH检出率差异有统计学意义(P<0.05),合并高危因素越多,DDH检出率越高。被检的3000个髋关节中,髋关节异常率14.00%,异常髋关节中,Ⅱc型9.80%,Ⅱd型2.33%,Ⅲ型1.37%,Ⅳ型0.50%。测量Ⅱc型、Ⅱd型、Ⅲ型髋关节α、β角发现,相比正常髋关节,异常髋关节α角显著变小,β角显著变大(P<0.05)。Graf法超声诊断DDH准确度为99.80%,敏感度为98.59%,特异度为100.0%。结论对具有高危因素婴儿采用Graf法超声筛查DDH,能够早期诊断,特别是合并多种高危因素的婴儿;且Graf法超声对于婴儿发育性髋关节发育不良具有良好的诊断效能。     

Graf法超声检查在发育性髋关节异常诊断中的应用

目的探讨Graf法髋关节超声检查技术在6个月龄以内婴儿的发育性髋关节异常（DDH）诊断中的应用价值。方法对年龄在6个月龄以内体检有阳性体征的472例婴儿（共计944个髋关节）行Graf法髋关节超声筛查。结果472例行超声检查的婴儿中可疑59例,最终被确诊为DDH婴儿8例,占阳性体征儿童的1．69％,8例在治疗中超声随访,治疗3～6个月后8例患儿均治愈。结论Graf法髋关节超声检查技术是早期诊断DDH较为可靠的方法,是监测和指导DDH治疗与随访的重要影像技术。     

Graf法超声对婴幼儿发育性髋关节发育不良的早期应用价值

目的 探讨Graf法超声检查在婴幼儿发育性髋关节发育不良(DDH)早期诊断及随访中的价值,为今后将髋关节超声检查作为0～6个月婴幼儿DDH早期普查或高危新生儿筛查的首选项目提供理论依据。方法 选取2021年3月至2021年8月南京市江北新区妇幼保健所儿童保健门诊健康查体的408例0～6个月婴幼儿作为研究对象进行Graf法超声DDH筛查,并对DDH婴幼儿早期随访,对筛查和随访结果进行统计分析。结果 408例婴幼儿816个髋关节中,DDH 45例,共53个髋关节,总检出率6.50%(53/816);生理性不成熟35例,需要干预治疗10例;DDH以单侧较常见,左侧较右侧多见(P=0.016),且Ⅱb型、Ⅱc型及D型主要见于左侧;女性DDH发病率高于男性(P=0.004);随访的48个DDH髋关节中38个生理性不成熟髋关节自然发育成熟的比率为94.74%(36/38);自然转归率为77.08%(37/48),临床干预治疗率为22.92%(11/48)。结论 Graf法超声无创、方便、可重复性高,在0～6个月婴幼儿DDH的早期筛查和治疗随访中具有重要的应用价值。     

Graf法超声筛查对发育性髋关节发育不良高危婴儿的诊断价值

目的:探究对发育性髋关节发育不良高危婴儿实施G r a f法超声筛查的诊断价值.方法:从我院2018年4月—2020年8月择取80例发育性髋关节发育不良高危婴儿作为研究组,择取同期健康体检婴儿80例作为对照组,所选婴儿均实施Graf法超声筛查,对照分析两组α角、β角,并对照病理诊断结果,对Graf法超声筛查结果进行分析...     

超声筛查新生儿发育性髋关节异常

目的 探讨Graf法髋关节超声诊断在婴儿发育性髋关节异常(DDH)筛查和随访中的作用.方法 对662名6月龄以内婴儿(1324髋)行Graf法髋关节超声筛查.通过观察骨性髋臼、骨性髋臼外侧缘、软骨性髋臼形态及测量α角、β角,对髋关节进行Graf分型.对性别、侧别、胎位、襁褓方式等DDH发病影响因素进行评价.对需要跟踪观察或治疗的发育不成熟、发育不良及脱位病例进行超声随访.结果 本组选择性超声筛查DDH的检出率为7.42%.性别、妊娠胎位是DDH发病的影响因素.27例发育不良与5例髋关节脱位在治疗中接受了超声随访,13例发育不良病例经外展操锻炼超声指标达到正常,14例因改善不明显接受Pavlik吊带治疗,5例脱位经Pavlik吊带治疗无效而接受闭合复位加外固定手术治疗.结论 超声检查能对婴儿髋关节发育情况进行客观评估,监测DDH治疗过程并指导临床治疗方案,可作为婴儿DDH早期筛查与随访的主要手段.     

超声改良Morin法在婴儿发育性髋关节发育不良筛查中的应用效果研究

目的探讨分析超声改良Morin法在婴儿发育性髋关节发育不良(DDH)筛查中的应用效果。方法选取2016年1月至2019年1月在某院进行婴儿DDH超声筛查的6月龄以内的婴儿1596例(3192侧髋)作为本次研究对象,所有婴儿均采用彩色多普勒超声诊断仪检查,并分别运用Graf超声测量法和改良Morin超声测量法进行诊断筛查。比较两种超声测量法诊断DDH的检出情况,并进行筛查结果的一致性检验。结果Graf超声测量法和改良Morin超声测量法分别检出15例、13例DDH,检出率分别为0.47%、0.41%。Graf超声测量法筛选出Ⅱb、Ⅱc、D、Ⅲ、Ⅳ型分别4侧、4侧、3侧、2侧、2侧。改良Morin超声测量法筛选出髋关节松弛、半脱位、脱位分别为6侧、4侧、3侧。两种超声测量法筛查DDH的Kappa值为0.791,两者的一致性良好。结论在婴儿DDH的临床筛查中,采用改良Morin超声测量法进行诊断,分型标准简单易行,且筛查结果与传统Graf法相当,可作为临床首选的DDH筛查的简便手段。     

超声筛查婴幼儿发育性髋关节发育不良的临床价值

探讨超声Graf法筛查婴幼儿发育性髋关节发育不良(DDH)的临床价值。选取2012年3月~2017年1月我院收治75例DDH婴幼儿(DDH组)、90例非DDH婴幼儿(非DDH组)作为研究对象,所有研究对象均接受髋关节超声Graf法检查。两组婴幼儿性别(χ~2=0.1610,P=0.7064)、年龄(u=0.7040,P=0.4825)、体质指数(u=1.3316,P=0.1849)比较差异无统计学意义(P>0.05)。超声Graf法诊断DDH的灵敏度、特异度、阳性预测值、阴性预测值、诊断准确度分别为89.3%、100.0%、100.0%、91.8%、95.2%。超声Graf法筛查DDH的临床价值确切,其灵敏度、特异度均较高,该方法值得临床推广应用。     

发育性髋关节异常常规超声检查的临床诊断价值

目的 探讨常规超声检查在诊断临床疑似发育性髋关节异常患儿中的应用价值.方法 1208例临床疑似发育性髋关节异常患儿,依据Graf常规超声检查法,评估双侧髋关节冠状面髋臼形态、股骨头位置及α、β角度并进行髋关节分型.结果 临床疑似病例中7%超声诊断为发育不成熟型(Ⅱa型和Ⅱb型),1.3%为病理型(Ⅱc型,Ⅲ型,Ⅳ型及D型).髋关节α、β角男女间差异均有统计学意义(P＜0.05),左右两侧α角差异有统计学意义(P＜0.05).α角与β角呈正相关(r=0.042,P＜0.05).结论 常规超声检查能减低晚期发育性髋关节异常的发生率,与临床体格检查法比较,应用Graf超声检查法能减少过度治疗,为临床提供了一种可信赖的检查方法.     

新生儿髋关节超声检查方法与技巧

目的 探讨Graf髋关节超声诊断法在新生儿髋关节超声检查和图像分析中的应用技巧,并了解新生儿期髋关节的发育状况.方法 征得家长同意后选择112例新生儿进行髋关节超声检查.每例新生儿均行双侧髋关节超声检查,在获得标准髋关节冠状面超声图像后冻结图像,每个髋关节留取3张图像,取其中1张标准且清晰的图像进行测量,122例双侧髋关节共获得224张图像.运用Graf法对图像进行测量并记录结果,按角度名称将测量结果分为α组和β组.2张髋关节超声图像因α角、β角无法测量,排除在角度测量统计分析之外,对其余222张髋关节超声图像的测量结果应用SPSS 17.0统计学软件处理.结果 122例新生儿224张髋关节超声图像中,Ⅰ型髋关节114个(50.89%,114/224),Ⅱ型髋关节105个(46.88%,105/224),D型髋关节3个(1.34%,3/224),Ⅲ型髋关节1个(0.45%,1/224);Ⅳ型髋关节1个(0.45%,1/224).α组与β组均呈正态分布,新生儿α角可信区间(59.67±0.41)°,β角可信区间(71.78±0.61)°,两组检查结果呈负相关(r=0.46,P<0.01).结论 运用髋关节超声检查一些技术方法与技巧,可很好理解髋关节超声诊断Graf法,获得高质量的检测图像,及时对新生儿髋关节发育状况作出评价,为临床提供有意义的参考依据.     

Reproducibility of acquiring ultrasonographic infant hip images by the Graf method after an infant hip ultrasound training course

Purpose

The objective screening of infant hips using ultrasonography (Graf method) is gaining favor in the diagnosis of developmental dysplasia of the hip in Japan. However, the accuracy of the Graf method is dependent on the examiner’s experience and technique. The purpose of this study was to investigate the reproducibility of acquiring ultrasonic hip images and their evaluation after examiners attended an infant hip ultrasound training course.

Materials and methods

Ultrasonic images of 70 hips of 35 newborns who were screened by ultrasonography using the Graf method, were evaluated. The images were acquired by two inexperienced examiners who attended the training course. The inter- and intra-examiner measurement errors as well as reproducibility were calculated based on the images obtained.

Results

The intra-examiner measurement error in the acquired images of the same hip was minor. The inter-examiner measurement error was also small. The intra- and inter-examiner agreements of the Graf classification were high. The intra-examiner reproducibility of the acquired ultrasonic images was substantial, and the inter-examiner reproducibility was almost perfect.

Conclusions

Our results demonstrated that inexperienced examiners could obtain ultrasonic infant hip joint images with minor differences and high reproducibility after the training course. Our findings raise the possibility of extending the infant hip ultrasound course in Japan.

     

The role of ultrasound in gynecological emergencies.

The expanding use of ultrasonography in gynecology puts increasing strain on the resources of ultrasound departments; any mechanism to increase the diagnostic efficiency of the scan and reduce unwarranted investigation would, therefore, be welcome.This prospective study examines the use of abdominal ultrasound examination in gynecological emergencies over a 6-month period in a London teaching hospital. The examination changed the clinical management in 33% of cases where the pregnancy test was positive, but in only 14% where it was negative. In the former group, the confirmation of viable intrauterine pregnancy reassured both patient and clinician in 84% of the cases, making the test a useful investigation in 89% of the total cases where the pregnancy test was positive. When the pregnancy test was negative, the ultrasound scan was more likely to be useful if requested by doctors with gynecological experience. In cases of incomplete spontaneous abortion, ultrasound was not found to be a useful investigation.Access to ultrasound equipment by, and basic ultrasound training of admitting junior doctors with gynecological experience would reduce referrals to the ultrasound department and reduce admissions to hospital, whilst improving appreciation of the role of ultrasound in gynecological emergencies.     

High-resolution hip ultrasound in the limping child

Hip ultrasound was performed on 44 children (114 exams) presenting with a painful hip or a limp thought to be due to hip disease. Effusions were found in 20 patients (21 hips). Hip ultrasound in combination with aspiration of the joint was found to be useful in diagnosis of osteomyelitis and septic joints, transient synovitis, trauma, and traumatic synovitis. We had no false positives or false negatives for hip effusions by ultrasound. In previous reports, absolute measurements have been relied upon for determination of hip effusions. We present a characteristic appearance of a capsule with and without abnormal joints fluid. The results of these 44 patients are summarized.     

The role of endoscopic ultrasound in inflammatory bowel disease

Ultrasonography has been applied to the diagnosis and management of inflammatory bowel disease for over 20 years. The combination of endoscopy with ultrasound has resulted in the application of intraluminal sonographic imaging to multiple diseases, including inflammatory bowel disease. Initial efforts were focused on the sonographic assessment of disease severity as based on bowel wall thickness, but this has been inconsistently demonstrated. Furthermore, disease severity is a clinical assessment that is based on both clinical and imaging studies. Recognizing that Crohn's disease tends to be transmural and ulcerative colitis a superficial mucosal inflammatory process, hopes were raised that endosonography would be effective in discriminating cases of otherwise indeterminate colitis. Efforts to demonstrate this, however, have been largely disappointing, and EUS plays a limited role in discriminating ulcerative colitis from Crohn's disease. On a more positive note, EUS evaluation of perirectal and perianal complications of Crohn's disease has been demonstrated to be superior to fistulography, CT, and equal to or superior to MRI. Because accurate anatomic information is required to guide surgical therapy of these lesions, EUS has the potential to emerge as a powerful imaging tool in the management of perianorectal Crohn's disease.     

超声造影对胰腺占位病变的诊断应用价值

目的 观察胰腺占位病变超声造影灌注特征，比较超声造影及其他方法对胰腺良恶性病变的诊断价值。方法 81例临床或超声、CT疑诊胰腺占位性病变行实时灰阶谐波造影（CEUS），其中经手术或临床资料、随访证实并明确诊断的72例胰腺占位性病变为重点研究对象。超声造影剂采用Sono Vue，观察良性病变、恶性病变、非肿瘤区域胰腺实质CEUS的增强时相和模式。结果 最终确诊良性病变18例，恶性病变54例，正常胰腺实质72例，三组间增强时相有差异。恶性病变造影开始增强时间晚于胰腺实质，开始减退时间早于胰腺实质，渡越时间短于胰腺实质及良性病变。良性病变与胰腺实质各时相无明显差异。造影剂增强模式恶性病变多为肿瘤周边增强、内部有不规则无增强区；良性病变多呈均匀整体增强。本组良恶性病变CEUS、增强CT、穿刺活检诊断正确率分别为87．5％（63／72例）、81．8％（54／66例）、95．1％（39／41例），均与常规超声的56．9％（41／72例）差异有统计学意义。结论 CEUS能够提供更多的血流灌注特征，为胰腺病变的诊断及鉴别诊断提供参考依据，诊断率与增强CT相近，有较高的临床应用价值。     

The role of ultrasound in biliary and pancreatic diseases

The possibilities and the limits of transabdominal ultrasonography (US) in the diagnosis of bilio-pancreatic diseases are reviewed here in the light of the last 10 years' research. US remains the method of choice for the diagnosis of gallstones and is generally accepted as an initial imaging technique in gallstone complications, such as acute cholecystitis. Moreover the method can be useful for the detection of the biliary complications after laparoscopic cholecystectomy and after liver transplantation. US is still considered the first diagnostic procedure when stones are suspected in the common bile duct. The use of color Doppler can provide a differential diagnosis of gallbladder cancer with respect to other benign inflammatory or polypoid lesions. Color Doppler US allows to detect vascular complications of acute pancreatitis such as pseudoaneurysms. US is still considered useful for the initial screening of the pancreatic cancer. However, for staging other imaging techniques must be employed. With US useful informations are obtained in the diagnosis of cystic tumors of the pancreas and of pancreatic metastases. US is generally of little use for the diagnosis of endocrine tumors.